Doctor Name: | LESTER RUSS REICHEK |
NPI Number: | 1194072181 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | GFE36336 |
Business Practice Address: | 310 San Juan Ave Santa Cruz, CA - 950621244 |
Business Phone Number: | 8314694053 |
Business Fax Number: | 8314261808 |
Mailing Address: | 310 San Juan Ave, SANTA CRUZ |
State: | CA |
Postal Code: | 950621244 |
Phone Number: | 8314694053 |
Fax Number: | 8314261808 |
NPI Enumeration Date: | 08/08/2012 |
NPI Last Update Date: | 08/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | GFE36336 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |